Lithium Nephropathy Clinical Presentation

Updated: Jan 18, 2022
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Generally, lithium nephrotoxicity will occur within a month of onset of use of the drug, manifested predominantly by polyuria and polydipsia. The onset of these symptoms may also occur in the presence of accelerating dose regimens. Initially, these symptoms are reversible but may become permanent with long-term use and/or chronically high serum lithium levels. When acute kidney injury occurs in the setting of lithium toxicity, the patients generally will exhibit other signs of lithium toxicity, such as obtundation. In particular, elderly patients with acute kidney injury may develop delirium, with confusion, tremors, and ataxia. [25]


Polyuria, defined as a 24-hour urine output of greater than 3 L, is the most common complication in an otherwise asymptomatic patient who has a plasma lithium level consistent with therapeutic dosing. [26] Patients may develop polydipsia. In one case report of persistent lithium-induced nephrogenic diabetes insipidus, the patient drank 20-40 glasses of water per day.

Nocturia can be a useful marker of polyuria. Up to 68% of patients report at least 1 urination episode per night.



Patients with lithium nephrotoxicity may exhibit signs of modest volume depletion, including orthostatic hypotension, tachycardia, and dry mouth. With severe dehydration, patients will show evidence of hypernatremia, including altered mental status.

  • Signs of volume depletion - Hypotension, orthostasis, tachycardia, and dry mouth

  • Altered mental status.

  • Occasional signs of hypothyroidism, including impaired reflexes and bradycardia

  • Signs of cardiotoxicity, including cardiac conduction blockade, SA node dysfunction, T wave flattening and inversion, and cardiovascular collapse